Provider Demographics
NPI:1073759858
Name:TAIANO, MARCELO (SI)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:TAIANO
Suffix:
Gender:M
Credentials:SI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CEDAR ST
Mailing Address - Street 2:B-34
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1016
Mailing Address - Country:US
Mailing Address - Phone:914-693-1480
Mailing Address - Fax:
Practice Address - Street 1:100 CEDAR ST
Practice Address - Street 2:B-34
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1016
Practice Address - Country:US
Practice Address - Phone:914-693-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14980253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY931031101OtherGHI